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Individual

QUINCIE GRANT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSE CCC-SLP

Contact information

Practice address
2604 POST OAK ST, JONESBORO, AR 72401-5652
(870) 926-8689
Mailing address
2604 POST OAK ST, JONESBORO, AR 72401-5652
(870) 926-8689

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP#457
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
156873721
AR
01
430037181
TRICARE HUMANA
AR
01
SP 5Y396
BCBS NUMBER
AR
Enumeration date
04/18/2007
Last updated
05/07/2008
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